June 26, 2017

Poverty, Dog Ownership, and Canine Rabies Vaccination in Uganda

Results from a survey conducted in Uganda revealed that poverty level heavily influences dog ownership and canine rabies vaccination coverage in that country.
By JoAnna Pendergrass, DVM
Results from a knowledge, attitudes, and practices (KAP) survey conducted in Uganda revealed that poverty level heavily influences dog ownership and canine rabies vaccination coverage. Survey results were recently published in Infectious Diseases of Poverty. This study, according to the researchers, “represents one of the most comprehensive attempts to characterize the dog population and rabies risk in Uganda.”
 
Rabies is a global health threat that kills almost 60,000 people per year, with approximately 19,000 of these deaths occurring in sub-Saharan Africa.

The canine rabies virus variant has been eliminated from most developing countries. However, it remains prevalent in sub-Saharan Africa, where rabies intervention programs have been unsuccessful.
 
Success of these intervention programs has been stymied in sub-Saharan Africa largely because rabies is not recognized as a significant health threat there. In addition, rabies surveillance is lacking across Africa, particularly in Uganda. Without adequate surveillance, risk models have been developed to estimate human and animal rabies burden. However, these models have not considered dog ecology and are not country-specific.
 
Study Design
In 2013, researchers conducted a 65-question KAP survey on dog ownership and rabies vaccination in 24 Ugandan villages. Survey results were analyzed at the household and village levels. Several variables at each level were included in the analyses:
  • Household-level: Household size, owned livestock value, level of dog care provided
  • Village-level: Population density, poverty level

Poverty was defined as living below the international poverty level of $1.25 per day. Researchers also estimated the population of owned dogs, canine rabies vaccination coverage, and human rabies risk using statistical models.
 
Results and Discussion
In the 24 villages, 798 households representing 4375 people completed the survey. Of these households, 13% owned dogs. The total number of owned dogs was 175, making the human:dog ratio 25:1.
 
Population density and poverty level varied widely between villages. The average village poverty level was 45%—higher than Uganda’s national average of 38%.
 
Nearly 60% of owned dogs had a previous rabies vaccination. This rate, although surprisingly high, was still below the threshold for effective herd immunity (70%) and was heavily influenced by poverty level.
 
The most common reasons for a dog being unvaccinated were lack of rabies vaccine access and no government vaccination, likely reflecting that vaccine availability is limited to Uganda’s periodic national vaccination campaigns. Notably, these reasons were given only in the areas where poverty is highest.
 
Several variables were significantly associated with likelihood of dog ownership or canine rabies vaccination:
  • Dog ownership: Household size, poverty level, owned livestock value, home building material quality
  • Vaccination rate: Population density, dog age, dog confinement
 
Researchers determined that human population density and poverty level significantly affected estimates of Uganda’s owned dog population and canine rabies vaccination rate. When adjusted for poverty, the human:dog ratio of 25:1 nearly doubled to 47:1 and the 57% rabies vaccination rate dropped to 35.4%.
 
A modeled estimate indicated that 90% of Ugandans live in areas where enzootic rabies transmission could occur.
 
“The findings from this study,” the authors wrote, “should be used to enhance current mass canine rabies vaccination strategies in Uganda, through the strategic use of resources where they will have the greatest impact.”
 
For the future, the authors advised further validation of this study’s modeled estimates. These estimates, they noted, can guide rabies vaccination strategies but should not replace routine rabies surveillance.
 
 
Dr. JoAnna Pendergrass received her Doctor of Veterinary Medicine degree from the Virginia-Maryland College of Veterinary Medicine. Following veterinary school, she completed a postdoctoral fellowship at Emory University’s Yerkes National Primate Research Center. Dr. Pendergrass is the founder and owner of JPen Communications, a medical communications company.

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